Exploration of an extended role for pharmacists : provision of nutritional advice to patients utilising opioid replacement therapy

  • Freya Waddington

    Student thesis: Doctoral Thesis


    The pharmacist's role typically includes providing information on the proper use, possible adverse effects, and precautions for dispensing medications. As one of the largest retailers of nutritional and dietary supplements in Australia, pharmacists are well placed to provide the same level of counselling service to accompany the provision of nutritional products. Enabling patients to manage their health through nutritional education and counselling is a recognised opportunity for pharmacists to increase their scope of practice and public health promotion.
    Patients utilising Opioid Replacement Therapy (ORT) are required to frequently interact with pharmacists in the community pharmacy setting to receive their treatment. International research has identified that these patients may be at risk of poor nutritional health. Nutritional deficiencies can negatively affect these patients’ recovery and lead to suboptimal health outcomes.
    This thesis aims to better understand the Australian pharmacist's current role regarding the supply of nutritional supplements and seeks to explore a potential role for pharmacists as providers of nutrition-based health interventions to an at-risk population, patients utilising ORT. This thesis explores the pharmacist's knowledge base of nutritional products to achieve this. It looks to understand how community pharmacists may leverage this knowledge and utilise their capacity as one of the most accessible primary health care providers to assist a population with identified nutrition-related risk factors.

    Six specific studies, incorporated in Chapters 2 through 7, were conducted to address the aims of this thesis. The first of these (Chapter 2) systematically reviewed the existing international literature investigating pharmacists’ level of knowledge of nutritional supplements. Outcomes from this review informed the second study (Chapter 3), which aimed to evaluate Australian pharmacists’ knowledge of the efficacy and safety of nutritional products most frequently utilised by Australian consumers. The third study (Chapter 4) involved a cross-sectional exploration of the work of Australian hospital pharmacists. This work sought to determine if the scope of the Australian hospital pharmacist's role includes working with nutritional products. The final three mixed methods studies (Chapters 5 through 7) focused on patients utilising ORT as a population potentially at risk of nutritional deficiencies, seeking to define a potential role for community pharmacists in performing nutritional interventions for these patients. A second systematic review (Chapter 5) was conducted to determine the extent of existing literature investigating the international nutritional status of patients utilising ORT. A cross-sectional pilot study was subsequently conducted as the fifth study (Chapter 6) to determine any potential nutritional deficiencies in an Australian population of patients utilising ORT and to assess whether these patients are receptive to nutritional advice provided by a pharmacist. Finally, in Chapter 7, Australian community pharmacists were interviewed to determine their experiences, beliefs, and perceived barriers to providing nutritional interventions for patients utilising ORT.

    When assessed for knowledge of nutritional supplements with a defined clinical effect, the mean knowledge score (converted into a percentage) obtained by Australian pharmacists was 62%. This finding is reflective of international trends of pharmacist knowledge of such products.
    The role of the Australian hospital pharmacist in performing nutritional supplement-based interventions is unclear. The results of this thesis suggest that Australian hospital pharmacists do not currently appear to be involved in undertaking tasks that include recording or communicating nutritional supplement use. Hospital pharmacists are not involved in selling pharmaceutical products, exerting their role chiefly through managing the medication reconciliation processes.
    The systematic review results in Chapter 5 and the pilot study in Chapter 6 found that patients utilising ORT appear at risk of developing several nutritional deficiencies, reported internationally and within Australia. Specifically, Australian patients utilising ORT were found to have potentially inadequate energy and intake of various macro and micronutrients. Regarding receptivity to pharmacist-provided nutritional advice, fewer 25% of patients utilising ORT surveyed indicated awareness of nutritional supplement use. However, 15% of male and 21% of female patients utilising ORT stated that they had approached a pharmacist with a nutrition-related query. All patients utilising ORT who received nutritional advice stated that they had followed it.
    In terms of pharmacists’ potential to provide nutrition-based interventions, when surveyed, pharmacists reported spending an average of 2-5 minutes when interacting with patients utilising ORT. During their interactions, pharmacists observed suspected potential nutrition-related health issues in their patients. Pharmacists who interacted with more patients utilising ORT are significantly more likely to believe that this patient group could benefit from nutritional advice (rho=0.515, p=0.034). Further, pharmacists who interacted with more patients utilising ORT were significantly more likely to have been asked nutrition questions (rho=0.618, p=0.008).
    Finally, despite the above, pharmacists identified several barriers to providing nutritional interventions to patients utilising ORT, including most predominantly, a lack of knowledge and confidence.

    The findings of this thesis highlight patients utilising ORT as vulnerable and at risk of several potential nutritional deficiencies. Patients utilising ORT interact with community pharmacists frequently, and this research has illustrated that at least some of these patients are receptive to nutritional advice when pharmacists provide it. Pharmacists hold a reasonable level of knowledge regarding the use of nutritional supplements and appear to recognise a potential nutritional need in patients utilising ORT. However, pharmacists also identify several barriers to providing advice in this area.
    These results indicate a requirement for specialised and targeted education for pharmacists, to not only improve their knowledge of nutrition and nutritional supplements, but also to assist in breaking the barriers to extending pharmacists’ scope of practice and providing health interventions for this at-risk population.
    Date of Award2023
    Original languageEnglish
    Awarding Institution
    • University of Canberra
    SupervisorGreg Kyle (Supervisor), Mark Naunton (Supervisor), Jackson Thomas (Supervisor), Gabrielle O'Kane (Supervisor) & Gabrielle Cooper (Supervisor)

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